QUALITY IMPROVEMENT IN NURSING

Quality Improvement in Nursing

Quality Improvement in Nursing

Q) Discuss the quality improvement process. Do-plan-check-act.

A quality improvement cycle is a planned sequence of systematic and documented activities aimed at improving a process

Improvements can be effected in two ways:

By improving the process itself and/or

By improving the outcomes of the process.

A quality improvement cycle can typically be defined into the four steps of Plan, Do, Check and Act (also known as the PDCA cycle). (Nelson, 2005)

The plan-do-check-act cycle (Figure 1) is a four-step model for carrying out change. Just as a circle has no end, the PDCA cycle should be repeated again and again for continuous improvement.

Figure 1: Plan-do-check-act cycle

Plan - the change

This can include:

selection of the change or identification of the need to implement change

reflection on and interpretation of relevant information concerning the existing process - this should be drawn from as wide a range of sources as possible and include information from clients and stakeholders

definition of the current process and the opportunities for improvement(Steel, 2000)

planning of how you will monitor the progress and the effectiveness of the change

Documentation of your goals and objectives - what improvements/changes do you expect to see?

Do - implement the change

carry out the change or new practice

document the activities of implementation

Check - monitor and review the change

This can include:

monitoring the progress and effectiveness of the change according to your plan

recording of observations and results (planned and unexpected) in comparison with the original data or the project goals, measures and objectives

Studying the results - what did you achieve?/ what did you learn?

Checking can go on continuously throughout the whole improvement cycle.

Act - revise and plan how to use the learning

Ask questions such as:

What will you do with the learning - adopt them, abandon them, run them through another PDCA cycle again to test?

What did the information you collected tell you about the effectiveness of the change?

What can be done to improve the process further?

How can the change be refined?

What lessons have you learned that can be applied elsewhere? How can these lessons be communicated?

Q) Differentiate between quality improvement and quality assurance in healthcare.

Quality assurance grows out of medicine's tradition of individual physician responsibility for the patient. In this tradition, the quality and results of medical care depend primarily on the physician's knowledge, judgment, and selection of support staff. Whereas, quality improvement starts with very different traditions and assumptions. It comes from mass production, assembly-line industry where the bulk of the work is repetitious and anonymous. Industry typically expects little if any ethical or social obligation between worker and consumer and not even much between worker and employer. Obligations may be specified in a collective bargaining agreement or in a job description rather than by a professional relationship. The worker often sees employment as simply a way to earn a living and sees the employer as a large faceless organization interested mainly in profit. (Nelson, 2005)

Quality assurance and improvement will remain a slow, painstaking, and time-consuming business. In general, the American health system has moved ...